BCI-FES Therapy for Stroke Rehabilitation

STATUS

Recruiting
participants needed

80
sponsor

University of California, Irvine

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Updated on 19 February 2024

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stroke

weakness

spasticity

foot drop

electrical stimulation

intracranial hemorrhage

ischemic stroke

stroke rehabilitation

Summary

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There are over 7 million stroke survivors in the US alone, with approximately 795,000 new cases annually. Despite the best available physiotherapy, 30-60% of stroke survivors remain affected by difficulty walking, with foot weakness often being the main cause. Given that post-stroke gait impairments remain poorly addressed, new methods that can provide lasting improvements are necessary. Brain-computer interface (BCI) technology may be one such novel approach. BCI technology enables "direct brain control" of external devices such as assistive devices and prostheses by translating brain waves into control signals. When BCI systems are integrated with functional electrical stimulation (FES) systems, they can be used to deliver a novel physical therapy to improve movement after stroke. BCI-FES systems are hypothesized to stimulate recovery after stroke beyond that of conventional physical therapy.

Description

Preliminary research indicates that applying this technique to foot weakness after stroke is safe and may improve walking function. Hence, this warrants further investigation to: 1. determine if BCI-FES therapy can provide lasting gains in walking in chronic stroke patients; 2. determine what factors influence BCI-FES therapy; and 3. explicitly elucidate the underlying neural repair mechanisms. First, a Phase II clinical trial in patients with foot drop due to chronic stroke will compare the effect of BCIFES dorsiflexion therapy to that of dose- and intensity-matched standard physical therapy (Aim 1). Comparing the improvement in walking speed and other secondary outcome measures between the two groups will test if BCI-FES therapy provides functional and neurological gains beyond those of standard physical therapy. The relationship between the patient baseline characteristics (walking speed, ankle function, stimulated muscle responses, brain wave features, sensation) and the outcomes will determine what features influence responsiveness to BCI-FES dorsiflexion therapy (Aim 2). Finally, the underlying mechanism driving the improvements of BCI-FES will be studied (Aim 3). Determining that BCI-FES therapy can provide improvements beyond that of standard therapy may lead to a new treatment for stroke patients. The underlying mechanism can inform the design of future physical therapy techniques or improve current ones. Finally, BCI-FES therapy may ultimately become a novel form of physical therapy to reduce post-stroke disability, and in turn reduce the public health burden of stroke.

Details

Condition	INTRACRANIAL HEMORRHAGE, Ischemic Stroke
Age	18years - 80years
Treatment	BCI-FES dorsiflexion therapy, Physiotherapy one hour, Physiotherapy two hours
Clinical Study Identifier	NCT04279067
Sponsor	University of California, Irvine
Last Modified on	19 February 2024

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Eligibility		Yes	No	Not Sure
Inclusion Criteria
	Age18-80 years inclusively at time of consent
	Radiologically confirmed first unilateral stroke, ischemic or intracranial hemorrhage (ICH) in etiology, with day of onset 26-104 weeks prior to day of randomization
	Gait velocity<0.8 m/s at screening and baseline visits
	Foot-drop in affected limb as defined by dorsiflexion active range of motion (AROM) via goniometry in seated position foot dangling is less than passive range of motion and less than 15 degrees
	Plantarflexors spasticity<3 on modified Ashworth Scale
	Can walk >10 m (no ankle foot orthosis (AFO), but cane or walker permitted) at a supervised level
	Can tolerate FES with pain no more than 4 on pain analog scale and has adequate muscle response of TA dorsiflexion 10 degrees
	Passive Range of Motion at least +10 degrees ankle dorsiflexion in subtalar neutral
Exclusion Criteria
	A major, active, coexistent medical, neurological (apart from stroke) or psychiatric disease (apart from stroke), including alcoholism or dementia, orthopedic injuries, that substantially affects gait
	A major medical disorder that substantially reduces the likelihood that a subject will be able to comply with all study procedures or safely complete study procedures. This includes, but not limited to documented serious cardiac conditions, serious pulmonary conditions, legal blindness, end stage renal or liver disease, pulmonary embolism or deep venous thrombosis
	Resting systolic blood pressure above 170, diastolic blood pressure above 100 at screening and baseline evaluations
	Implanted electronic device (e.g. pacemaker) or skull metallic implants (e.g. cranioplasty plate)
	Deficits in communication that interfere with reasonable study participation: language or attention impairment (score>1 on NIH Stroke Scale items 9 and 11, respectively)
	Significant cognitive impairment, defined as Montreal Cognitive Assessment score < 22 (For those with aphasia: Because Montreal Cognitive Assessment scores may be difficult to interpret for patients with aphasia, at the discretion of the site's study PI, exclusion criterion #5 ("MoCA score cannot be <22") can be waived)6. A new symptomatic stroke occurs apart from the index stroke during the screening process and prior to randomization
	Life expectancy < 6 months
	Skin breakdown over electrical stimulation sites
	Received chemical denervation (eg Botox) to arms, legs, or trunk in the preceding 6 months, or expectation that chemical denervation will be administered to the arm, leg, or trunk prior to expected completion of the study
	Unable or unwilling to perform study procedures/therapy, or expectation of non-compliance with study procedures/therapy
	Pregnancy
	Significant pain (visual analog scale >4), chest pain, or shortness of breath with walking
	Receiving any outside concurrent physical therapy
	Any general medical condition and psychosocial situation that substantially interferes with reasonable participate in study appointments
	Non-English speaking, such that subject does not speak sufficient English to comply with study procedures
	Concurrent enrollment in another investigational interventional study
	Severe depression, defined as Geriatric Depression Scale Score >11
	Prior or concurrent use of FES orthosis for gait
	A new symptomatic stroke occurs apart from the index stroke during the screening process and prior to randomization
	If TMS Eligible (note that potential subjects who do not qualify for TMS will
	not be excluded from the main study, they will only be excluded from
	undergoing TMS procedures)
	\. TMS: Metallic hardware on the scalp (e.g. vascular clips or cranioplasty
	mesh)
	\. TMS: Implanted medication pumps, intracardiac line, or central venous
	catheter
	\. TMS: History of cortical stroke or other cortical lesion such as brain
	tumor
	\. TMS: Prior diagnosis of seizure or epilepsy
	\. TMS: Any electrical, mechanical, or magnetic implants
	\. TMS: History of neurosurgery
	\. TMS: uncontrolled Migraine headaches
	\. TMS: Any current medications that affect seizure threshold such as
	tricyclic antidepressants and neuroleptics
	\. TMS: Unstable medical conditions

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BCI-FES Therapy for Stroke Rehabilitation